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Estimation of serum ferritin level of a cohort of patients with sickle cell anemia in Port Harcourt, Nigeria.
Medrech
Abstract
Background: Iron overload remains a significant clinical concern in sickle cell anemia (SCA)
despite contrary reports of adequate iron stores and overt iron deficiency anemia in SCA. It has
therefore, become imperative to evaluate the iron status of sickle cell patients in Rivers state
Nigeria.
Methodology: This was a Prospective Study of 108 subjects comprising of 54 SCA patients and
54 aged, sex matched normal (HbAA) control. Serum ferritin was determined by
spectrophotometric method.
Result: The SCA patients had a mean serum ferritin level of 300200 g/L (range; 80 to 1,200
g/L) which was higher than the mean of 8822 g/L (range 12-150g) of the control group (P
< 0.001). There was a weak direct correlation between serum ferritin concentration and the
number of units of blood transfused (r = 0.25 (P = 0.061). Forty three (80%) of the SCA patients
had increased iron stores while eleven (20%) had adequate iron stores comparable to the healthy
control group. There was no serum ferritin level suggestive of iron deficiency anemia from this
study.
Conclusion: We therefore recommend sequential iron studies for patients on recurrent blood
transfusion, while iron supplementation should only be given in established cases of iron
deficiency anemia.
Keywords: SCA, Serum Ferritin, Iron status.
Introduction
Sickle cell disease (SCD) refers to a group of
disorders caused by the co-dominant
inheritance of two abnormal hemoglobin
genes including the sickle hemoglobin (HbS)
gene. These disorders include the
homozygote sickle cell anemia (HbSS) and
compound heterozygotes such as HbSC, SOArab, Sthal and SD.1 The mutant
hemoglobin S molecule (HbS) is the
dominant factor in the cascade of cellular
events, responsible for the pathogenesis of
the clinical features associated with SCD.
These include chronic hemolytic anemia,
Okoh D. A. & Nwabuko C. O., Med. Res. Chron., 2015, 3 (1), 97-101
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Okoh D. A. & Nwabuko C. O., Med. Res. Chron., 2015, 3 (1), 97-101
Estimation of serum ferritin level of a cohort of patients with sickle cell anemia in Port Harcourt, Nigeria.
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Okoh D. A. & Nwabuko C. O., Med. Res. Chron., 2015, 3 (1), 97-101
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Discussion
The patients with sickle cell anemia in this
study were found to have higher
concentration of serum ferritin than in the
control group of same age and sex. The mean
ferritin value of the SCA patients was
comparable to the findings reported by
oluboyode et al6 in Ibadan and Ikusemoro et
al in Benin 12. Likewise, the SCA patients
who previously had blood transfusion were
found to have higher, mean ferritin level,
compared to those who were never
transfused. However, similar to the report by
Oluboyede and colleagues, there was no
correlation
between
serum
ferritin
concentration and the number of units of
blood transfused. Ikusemoro et al12 on the
contrary observed a significant correlation in
their study. This may be attributed to the fact
that more than 30% of SCA patients in their
study population had multiple transfusions,
unlike in our study where only sporadic topup transfusions were given and none was on
chronic transfusion regimen. Inadequate
transfusion record of the individuals was also
a major limitation.
Although iron over load is a clinical concern
in SCA, unlike most congenital hemolytic
anemias; it does not occur without repeated
blood transfusion 13, 14Some studies have also
shown that iron deficiency, rather than iron
over load may be a problem especially, in the
non-transfused SCD population 7. However,
in this study, none of the SCA patients had
ferritin concentration suggestive of iron
deficiency anemia; rather, increased iron
store was observed in 43 (80%) of the SCA
group with 9% having values greater than
1,000g/L but not up to 1,800g/L15 which is
level often associated with a higher risk of
organ dysfunction. Coincidentally, according
(MDS
to
international
guidelines16
symposium) the serum ferritin level above
1,000g/L represents the threshold of the
target value for the initiation of iron chelation
therapy for patients on chronic transfusion
Okoh D. A. & Nwabuko C. O., Med. Res. Chron., 2015, 3 (1), 97-101
Estimation of serum ferritin level of a cohort of patients with sickle cell anemia in Port Harcourt, Nigeria.
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Okoh D. A. & Nwabuko C. O., Med. Res. Chron., 2015, 3 (1), 97-101
Estimation of serum ferritin level of a cohort of patients with sickle cell anemia in Port Harcourt, Nigeria.
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